DEGREE OF HYPERCOAGULABILITY AND HYPERFIBRINOLYSIS IS RELATED TO ORGAN FAILURE AND PROGNOSIS AFTER BURN TRAUMA

Severely burned patients often present a hypercoagulability situation. However, its magnitude, time course, and relationship with organ fail ure and outcome remains to be established. Forty-three patients were s tudied on the first and seventh day after burn for hypercoagulability and fibrinolysis parameters. A hypercoagulability and hyperfibrinolysi s state was found the first day after burn demonstrated by high levels of activated factor VII (VIIa, p<0.01), thrombin-antithrombin III com plex (TAT, p<0.01), tissue plasminogen activator (t-PA, p<0.001) and D dimer (DD, p<0.01) and low levels of antithrombin III (ATIII, p<0.01) , protein C (PC, p<0.01), plasminogen (PG, p<0.001) and alpha2 antipla smin (AP, p<0.001). A paradoxical coexisting hypofibrinolysis was foun d as suggested by a low global fibrinolytic activity in the euglobulin plasma fraction fibrin plate assay (FA, p<0.01) and high levels of ti ssue plasminogen activator inhibitor type 1 (PAI-1, p<0.01). On day 7, a less marked hypercoagulability situation was found, with low ATIII (p<0.01) and PC (p<0.01), persisting the hypofibrinolytic situation ob served on the first day. Non-survivors (NS) showed higher levels of VI Ia (p<0.01), TAT (p<0.05) and t-PA (p<0.05), and lower levels of ATIII (p<0.05), PC (p<0.05) and AP (p<0.001) than survivors (S) on the-firs t day. Also, there was a positive correlation of Marshall organ failur e score with ATIII, (r(2)=0.49, p<0.001), PC, (r(2)=0.14, p<0.045) and PG levels, (r(2)=0.41, p<0.0003). Severely burned patients show a sta te of transient disseminated intravascular coagulation, related to the development of organ failure and outcome. (C) 1998 Elsevier Science L td.